PhilHealth to settle hospital claims through debit-credit payment

MANILA, Philippines — State-run Philippine Health Insurance Corp. (PhilHealth) can now settle hospitals’ claims through the debit-credit payment method in all high risk and critical areas as the government seeks to expand the country’s health care capacity to accommodate more COVID-19 patients.

The Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) allowed the expansion of the application of the debit-credit payment method through Resolution No. 111 issued last April 22.

Under the resolution, the method used by PhilHealth to settle the accounts payable to health care facilities shall apply in high and critical risk areas as determined by the two-week growth rate, average daily attack rate and health care utilization rate.

These areas will also be prioritized in the COVID-19 vaccine allocation, human health resource deployment and other relevant pandemic responses.

Presidential Spokesman Harry Roque said PhilHealth initially applied the debit-credit payment method only to areas identified by the government’s pandemic task force – Metro Manila, Batangas, Bulacan, Cavite, Laguna, Pampanga and Rizal.

Officials previously said President Duterte’s directive for PhilHealth to pay hospitals with unpaid claims convinced medical institutions to allocate more beds for COVID-19 patients. The payments allowed hospitals to open more facilities for infected individuals.

Roque has said the commitment of hospitals to increase their COVID-19 facilities, especially intensive care unit beds, was crucial in Duterte’s decision to downgrade the classification of National Capital Region (NCR) Plus from the strictest enhanced community quarantine (ECQ) to the more lenient modified enhanced community quarantine last April 12.

Metro Manila and the nearby provinces of Bulacan, Cavite, Laguna and Rizal or NCR Plus were placed under ECQ from March 29 to April 11 to address the soaring number of pandemic infections.

According to a PhilHealth circular released this month, the debit-credit payment method involves the payment of 60 percent of the total applicable health care facility receivables subject to two percent expanded withholding tax for private eligible facilities.

The payment of the remaining 40 percent of the total amount of good claims would be subject to two percent expanded withholding tax for eligible private facilities following full compliance with existing claims processing requirements and procedures and full reconciliation of the 60 percent of the total amount of receivables initially paid to the facilities.

The Task Group Treat, the One COVID Referral System, the health department’s health facility development bureau and other agencies were also instructed to identify target additional beds on a weekly basis.

The NTF was also instructed to enhance the enforcement of COVID-19 strategies at the barangay level by engaging the Technical Education and Skills Development Authority for the development of relevant training and instructional materials.